1. Field of the Invention
The present invention relates to the field of medical treatments for reducing the size and effect of various adhesions or lesions in soft tissues, such as muscles, tendons, blood vessels, fascia, and nerves. More specifically, medical treatments according to the invention utilize an expert system for directing the non-surgical manual manipulation of soft tissues to identify and treat soft tissue adhesions that cause numbness, pain, and restricted range of motion.
2. Statement of the Problem
Unnecessary surgeries are sometimes performed because the medical profession lacks a unified and comprehensive training program for the non-surgical treatment of all types of soft tissue lesions. Prior treatments and training have focused on specific disorders, which results in an ad hoc overall level of expertise in the medical profession and a preference for surgical intervention. Medical practitioners are often unaware of non-surgical treatments offering higher success rates and less trauma to their patients than can be obtained from surgical pr. There is a need for an expert system to guide medical doctors, chiropractors, physical therapists, and occupational therapists in implementing protocols for the non-surgical treatment of all types of soft tissue lesions. This expert system would prevent unnecessary surgeries.
Historically, a preferred treatment modality has been the surgical excision of lesions, if possible, once they become problematic. These surgeries may not be needed even though they may be commonplace. By way of example, surgery for carpal tunnel syndrome can be performed to divide the transverse carpal ligament in a manner that relieves pressure on the median nerve. U.S. Pat. No. 5,501,657 to Feero reports that surgical techniques intended to relieve the syndrome have a failure rate ranging from 50% to 75%. The '657 patent teaches a non-surgical technique for the relief of pain associated with carpal tunnel syndrome. The massage technique includes stretching muscles of the forearm and hand combined with longitudinal manipulation of the forearm muscles to improve circulation. Even though the '657 patent does not identify a success rate for the technique that it teaches, the technique is said to be more successful than prior surgical techniques.
Surgical techniques for soft tissue injuries have low success rates because surgery cannot address all of the potential problem areas. Additionally, surgery itself produces trauma. Leahy in New Treatment of Carpal Tunnel Syndrome, Chiropractic Sports Medicine (1992) proposed a non-surgical technique for the treatment of carpal tunnel syndrome. Leahy recognized that carpal tunnel syndrome may involve lesions of the carpal canal, the median nerve, the radial nerve, the posterior interosseus nerve, the axilla, the anterior interosseous nerve, and the ulnar nerve. Thus, the blanket designation of `carpal tunnel syndrome` is inadequate to describe the afflicted anatomy with particularity.
Cumulative Injury Disorders
Cumulative injury disorders involve the soft tissues, and are now perhaps the most significant injury problem in the United States. Federal injury statistics indicate that cumulative injury disorders have worsened by six hundred and seventy percent in the last five years. A variety of injuries including carpal tunnel syndrome may be classified under the broad heading of cumulative trauma disorders or cumulative injury disorders. These disorders include a group of injuries to the muscles, tendons, bones, blood vessels, fascia, and nerves. The term `cumulative injury disorder` is preferred because actual trauma is not necessarily required to bring about the injury.
The three basic injury types include acute injuries, repetitive motion injuries, and constant pressure or tension injuries. Acute injuries result from the tearing of muscle and fascia, and are most often associated with immediate inflammation. Acute injuries trigger biological processes involving white blood cells, the production of fibrinogen, and the growth of adhesions. Adhesions also result from the other types of injuries.
Cumulative injuries result from the law of repetitive motion and the cumulative injury cycle. The law of repetitive motion may be modeled as: EQU I=NF/AR, (1)
wherein I is a relative quantity denoting an insult to the tissues; N is a number of repetitions; F is the force or tension of each repetition as a percent of maximum muscle strength; A is the amplitude of each repetition; and R is the relaxation time between each repetition. For example, a jackhammer operator is daily exposed to vibrations wherein N is high, A is low, and R is low. Thus, I is high. Formula (1) above shows that injuries may derive from constant pressure or tension that is without apparent or immediate trauma to soft tissues. Furthermore, cumulative injuries may result from isometric muscle contractions and poor posture with consequences including cellular calcium retention, poor cellular repair, and altered function.
The Cumulative Injury Cycle
The three basic injury types may all contribute to a cumulative injury cycle 100, as shown in FIG. 1. Repetitive motion injuries result in weak and tense tissues 102. Tissues that are adjacent to these weak and tense tissues may also be drawn tight. Weak and tense tissues produce corresponding internal forces 104 including friction and pressure. An acute injury 106, such as tearing or crushing on a microscopic or macroscopic level, can result from these internal forces. An isolated acute injury 106 can also commence cycle 100. Inflammation 108 results from the acute injury 106, and exacerbates the total problem by enhancing the weakness and tenseness of the injured tissues. Internal forces 104 also induce decreased circulation or edema 108. The effect of these internal forces is usually a decrease in circulation. The acute injury 106 and inflammation 108 contribute to cellular hypoxia from restricted circulation. This cellular hypoxia causes fibrosis and adhesions 110 to occur in and between tissues. Acute injury 106 and inflammation 108 combine to form an inflammation cycle 112 leading to adhesion and fibrosis 110. A chronic cycle 114 also leads towards adhesion and fibrosis 110. Chronic cycle 114 includes the effects of decreased circulation and edema 116. As indicated above, internal forces 104 lead to a decrease in circulation and an increase in internal pressure. The decrease in circulation may be enhanced by the continued application of external pressure, e.g., as from an elastic garment. Pressure applied over a low-pressure lymphatic channel causes swelling or edema, which also leads to adhesion and fibrosis 110.
Certain persons are predisposed to be more affected than others by injuries on the cumulative injury cycle 100. For example, smokers and diabetics have relatively poor circulation, which helps perpetuate the cycle. Thyroid deficits and hormonal changes increase musculature tension, and enhance the degree of weakness and tightness in the affected tissues.
The cumulative injury cycle 100 perpetuates itself, and afflicted persons find themselves in a downward spiral until the symptoms and syndromes of cumulative injury disorder are prevalent. Examples of cumulative injury disorders include carpal tunnel syndrome, cubital tunnel syndrome, epicondylitis, tenosynovitis, myofascitis, bursitis, peripheral nerve entrapment, thoracic outlet syndrome, De Quervain's disease, and others.
Conventional Treatment Methodology
Conventional training disposes those in the medical profession to a sequential protocol involving the treatment of patients, namely, history, evaluation, diagnosis and then treatment. The patient's history is taken to determine what symptoms the patient has experienced and for how long, what treatments have been applied, and what has been the effect of those treatments. In the evaluation stage, the patient may be subjected to testing that confirms symptoms or conditions that are to be expected in conjunction with respective diagnostic options. A diagnosis is made based upon the results of the history and evaluation stages. Only then is there adopted a treatment modality addressing the diagnosed problem.
The conventional approach is problematic in the diagnosis and treatment of soft tissue disorders because the evaluation is often flawed due to the ad hoc level of expertise in the medical profession. The physician selects a particular treatment based upon this diagnosis; however, the treatment may be flawed because it neglects some of the affected areas. The physician may also be bombarded with conflicting or incomplete reports of existing treatment modalities. For example, stretching and bending of the forearm according to Feero in U.S. Pat. No. 5,501,657 does not affect all of the nerves noted by Leahy. In another example, a physical examination or evaluation designed to detect carpal tunnel syndrome may lead to a diagnosis of carpal tunnel syndrome because a physician expects to see this disorder and has conducted the physical examination to confirm it. Surgery may subsequently be performed to relieve pressure on the median nerve, but symptoms of carpal tunnel syndrome may occur even when the median nerve is not compressed at the carpal tunnel.
There remains a true need for an expert system in diagnosing and treating soft tissue lesions. The expert system would avoid misdiagnosis and provide non-surgical treatment modalities having a greater chance of success than that which surgical techniques offer.